You might benefit from different types of insulin to improve your diabetes treatment. Find out about insulin options and how each works.

Over
the course of your diabetes treatment, you might be prescribed
several different types of insulin. Your insulin treatment could
begin with long-acting insulin but come to include short-acting
insulin, rapid-acting insulin, and pre-mixed insulin. Understanding
what each one does is important to managing your blood sugar.

Long-Term
Insulin Options for Blood Sugar Control

“Most
people with type 2 diabetes [who need insulin] start on a single,
long-acting insulin injection — basal insulin only,”
explains endocrinologist Anthony L. McCall, MD, PhD, a professor of
diabetes at the University of Virginia Health System in
Charlottesville. “Basal is a background insulin usually used as a
relatively steady dose — it’s not changed too often once
the right dose has been determined,” he says. “It ‘covers’
people even when they’re not eating or absorbing food.”

However,
over time you might find that this approach is no longer enough to
control your blood sugar. At that point, your doctor might talk with
you about other options, such as adding bolus, or short-acting,
insulin as an additional insulin dose before your biggest meal of the
day. This is called a “basal plus one.”

The
next step in insulin treatment may be a pre-mixed insulin. “Over
many years, some people with diabetes can become severely
insulin-deficient and may need insulin at any moderate or large meal,
depending on the meal composition," Dr. McCall says. "Pre-mixed
insulin is used for convenience, although it does provide a rather
inflexible way to give both basal and meal insulin.” This means you
can’t adjust your insulin dosage based on the food you eat, which
affects your blood sugar levels. Pre-mixed insulin is often
prescribed for people with poor eyesight or arthritis in the hands,
as they may have difficulty drawing up insulin doses from different
bottles.

Some
people prefer the flexibility of choosing the dose of short-acting
insulin they want to use in response to their blood sugar levels, the
specific meals they have planned, and other activities in their day
that could affect blood sugar. Although this might sound difficult at
first, McCall says most people have little trouble learning how to
manage insulin in this way.

It’s
important to periodically talk with your doctor about your insulin
treatment regimen and how best to use the different types of insulin.
Don’t assume a previous method is the correct way to administer a
new insulin prescription. For example, recent research published in
the journal Pharmacotherapy showed that when
switching from one particular long-acting insulin to another, some
people require a 33 percent higher dose to maintain similar levels of
blood sugar control.

A
Guide to the Different Types of Insulin

The
different types of insulin are:

Long-acting insulin. This type of insulin is given in one daily shot and is intended to help your body manage blood sugar levels all day and night. This insulin takes 6 to 10 hours to have an effect and lasts for 20 to 24 hours.

Short-acting insulin. This type of insulin is often referred to as bolus insulin, and a dose is taken before meals to control the release of blood sugar in response to the food you are about to eat. This insulin reaches your blood in 30 minutes, peaks about two to three hours after injection, and lasts three to six hours.

Pre-mixed insulin. This type of insulin contains a set mix of long- and short-acting insulin. McCall describes this as a good option for people who have a very consistent lifestyle and diet and who need the convenience of one shot a day.

Intermediate-acting insulin. This type of insulin reaches the blood two to four hours after you inject it, peaks 4 to 12 hours after injection, and lasts 12 to 18 hours. (It works faster than long-acting insulin and lasts longer than short-acting, making it a middle-ground, or intermediate, choice).

Rapid-acting insulin. This type of insulin works very quickly, hitting your blood five minutes after injection, peaking in about an hour, and lasting two to four hours. It is commonly used as mealtime insulin so the dose can be regulated depending on what you’ll be eating and how it will affect your blood sugar.

Your
overall health, medication administration preferences, and blood
sugar control will help determine the best insulin type for you. Work
closely with your doctor to determine the insulin regimen and dosing
schedule that’s right for you.

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